Method and apparatus for displaying medication information

ABSTRACT

A method, system, and article of manufacture for ensuring that the content and appearance of medication information is consistent, accurate, and reliable across multiple hospitals, sites, and users. Publicly available databases provide medication information. Relevant data is extracted from such databases and placed into a drug reference table. The drug reference table is combined with a hospital formulary such that the medication information in the formulary is modified, completed, reformatted, etc. Such modifications, completions, and reformatting are conducted by enforcing one or more rules that are applied to elements and attributes of a medication. The resulting medication information content is stored in a hospital formulary file that is accessed and utilized for maintaining, displaying, administering, etc. medication. To combine the drug reference table with the formulary, a hospital setup tool comprising a graphical user interface that allows a user to approve and finalize medication information may be utilized.

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] This application claims the benefit under 35 U.S.C. Section 120of the following co-pending and commonly-assigned U.S. utility patentapplication, which is incorporated by reference herein:

[0002] Utility Application Ser. No. 09/815,479, filed Mar. 23, 2001, byDonna B. Dulong, Steven R. Wehba, Douglas W. Comer, Joanne S. Stark,Michael A Kurtz, and Barbara Trohimovich, entitled “METHOD ANDAPPARATUSFOR DISPLAYING MEDICATION INFORMATION”, attorneys' docket number136.2-US-U1, which application claims the benefit under 35 U.S.C.Å119(e) of United States provisional application serial No. 60/191,955,entitled “SYSTEM AND METHOD FOR AUTOMATING MEDICATION ERROR DETECTIONAND PREVENTION,” filed on Mar. 24, 2000, by Donna B. Dulong, et. al.,attorney's docket number 136.2USP1, which application is incorporated byreference herein.

BACKGROUND OF THE INVENTION

[0003] 1. Field of the Invention

[0004] The present invention relates generally to the prevention oferrors in medication administration, and in particular, to a method,apparatus, system, and article of manufacture for consistentlydisplaying medication information.

[0005] 2. Description of the Related Art

[0006] The proliferation of new drugs and increasing complexity of drugtherapy has dramatically increased the incidence of medication errorsand adverse drug events in hospitals. With the aging of the population,hospitals are treating more elderly and acutely ill patients whoseability to tolerate medication errors is compromised. At the same time,economic pressure from managed care and reduced reimbursement rates frompublic and private payors have caused hospitals to increase thepatient/nurse ratio.

[0007] The process for administering drugs to patients has changedlittle in the past two decades. The process typically relies on verbaland written communication and involves several different clinicians fromvarious areas within a hospital. Medication errors occur at every stageof the medication use process—in physician prescribing, ordertranscription, drug preparation, drug dispensing, and in administrationto the patient. Existing information systems and automated drugdistribution systems only incidentally address the problem of medicationerrors.

[0008] Several recent studies have documented the alarming rate ofmedication errors and adverse drug reactions in hospitals and theirresulting deaths and related costs. Some of the findings are as follows:

[0009] 6.5% of patients will experience a potentially serious errorwhile hospitalized

[0010] over $4.0 billion in additional hospital costs are caused bymedication errors and adverse drug events

[0011] Recently, the awareness of the high level of medication errorswithin hospitals has increased significantly and many leading hospitalsin the United States have experienced highly publicized cases related tocatastrophic medical errors. Lawsuits associated with medication errorshave proliferated. In addition to the legal costs, hospitals'institutional reputations may be at risk if there is a highly publicizedpatient death due to medication error.

[0012] In response to the growing risks of medication errors, leadinghospitals have developed initiatives to focus on the issue. In addition,professional associations representing nurses, hospital pharmacists, andphysicians have identified medication errors as a major issue. TheHealth Care Finance Administration (HCFA) has discussed regulations thatwould exclude hospitals with high rates of medication error fromreimbursement under the Medicare program. As a result, manyconstituencies are seeking a standard of care within hospitals toaddress the problem of medication errors and adverse drug events.

[0013] A significant cause of medication error results from theinconsistent display and interpretation of medication information.Inconsistent displays and interpretations may arise at numerous stagesin the processing and administration of medication includingprescription interpretation, prescription order transcription and entry,medication dispensing (at a pharmacy), medication retrieval (by anurse), medication administration, etc.

[0014] For example, a doctor may desire to write a prescription for 10010 milligram tablets of medicine XYZ to be delivered orally 2 times aday. However, when writing the prescription, the doctor may writemedicine XYZ using an abbreviation (e.g., X), with a dosage of 100.0without indicating the dosage unit (e.g., mg (milligram) or μg(microgram)) or dosage schedule/frequency (e.g., 2 times daily), and mayfail to indicate the method of administration (e.g., oral). Such aprescription may not be consistently interpreted. For example, whenentering the prescription into a computer system, the pharmacist mayomit some of the missing important information, wrongly interpret theabbreviation, enter the information using abbreviations different fromthat used in the prescription (i.e., those used in the pharmacy's ownformulary), further abbreviate the remaining medication information(e.g., ×2 for two times daily), or incorrectly indicate a dosage of 1000micrograms to be taken three times a day. Further errors may occur whenthe prescription is filled by another pharmacist that may interpret theinformation in the computer (e.g., the abbreviations) differently, whena nurse misinterprets the computer display of the prescription andobtains the wrong medication from floorstock, or when a nurseadministers the medication and misinterprets the information.

[0015] Individual hospitals and pharmacies often use differentabbreviations/formularies for medication information. Consequently, whenpersonnel move from one hospital/pharmacy to another, there is a highlikelihood that the personnel will misinterpret the medicationinformation. Additionally, the medication information (andabbreviations) used on a prescription label may differ from themedication information displayed on the computer or on a medicaladministration record (MAR) that is used to record the status andtreatment of a patient. Such differences may result in a medicationerror during the administration of the medication.

[0016] What is needed is the ability to consistently display and storemedication information such that fewer errors are made when interpretingthe information in a computer or on a MAR. Additionally, what is neededis a consistent and complete display of medication information acrossmultiple sites.

SUMMARY OF THE INVENTION

[0017] A method and apparatus for consistently and accurately displayingmedication information. Medication errors result in a significant numberof injuries and deaths each year. One cause of medication errorsincludes the lack of consistence and reliability in the content andappearance of medication information. For example, different content forthe same medication or the use of different abbreviations or terms whendisplaying the same medication may lead to the misinterpretation orimproper use of a medication.

[0018] One or more embodiments of the invention provide a method,system, and article of manufacture for ensuring that the content andappearance of medication information is consistent, accurate, andreliable across multiple hospitals, sites, and users. Publicly availabledatabases provide medication information. Relevant data is extractedfrom such databases and placed into a drug reference table.

[0019] Different hospitals and pharmacies maintain internal formulariesthat store and provide access to medication information provided by thehospital/pharmacy. Such information is often incomplete, inconsistent,and varies from hospital to hospital.

[0020] The drug reference table is combined with the formulary such thatthe medication information in the formulary is modified, completed,reformatted, etc. Such modifications, completions, and reformatting areconducted by enforcing one or more rules that are applied to elementsand attributes of a medication. For example, rules may cause theconversion of a “T” in the formulary file to “TAB” to indicate amedication's route of administration. Similarly, leading or trailingzeroes may be removed, measurement unit abbreviations may be expanded oradjusted, capitalization may be adjusted, etc.

[0021] The resulting medication information content is stored in ahospital formulary file that is accessed and utilized for maintaining,displaying, administering, etc. medication.

[0022] To combine the drug reference table with the formulary, ahospital setup tool may be utilized. The hospital setup tool provides agraphical user interface with several columns. One column presentsmedication information from the formulary. A second column presentssuggested medication information from the drug reference table. Thesuggested medication information is obtained by attempting to match theformulary information with relevant fields in the drug reference table.For example, if the national drug code (NDC) information stored in theformulary matches a NDC number from the drug reference table, theappropriate medication information is retrieved and displayed in thesecond column.

[0023] A third column presents the final medication information to beutilized in the hospital formulary file. Such final medicationinformation may include a medication display description that will beused when the medication is displayed. The medication displaydescription comprises multiple elements of a medication and may beadjusted by the user, if desired. For example, the medication displaydescription may comprise a generic or brand display name of themedication (e.g., Morphine), followed by the strength and strength units(e.g., 200 mG).

[0024] Accordingly, a completed hospital formulary file reflectsaccurate and consistent medication information that the individualpharmacy or hospital has approved. Such medication information may thenbe utilized and displayed in a consistent manner to prevent medicationerrors. For example, all of the scheduled medications for a givenpatient may consistently display appropriate medication information foreach patient order. Such information may include the medication displaydescription and the dosage and route of administration information.

BRIEF DESCRIPTION OF THE DRAWINGS

[0025] Referring now to the drawings in which like reference numbersrepresent corresponding parts throughout:

[0026]FIG. 1 schematically illustrates a hardware and softwareenvironment in accordance with one or more embodiments of the invention;

[0027]FIG. 2 illustrates the flow of information that enables the useand display of appropriate medication descriptions in accordance withone or more embodiments of the invention;

[0028]FIG. 3 is a flow chart illustrating the use of a hospital setuptool in accordance with one or more embodiments of the invention;

[0029]FIG. 4 illustrates a graphical user interface utilized in mappingmedication information between a hospital/pharmacy formulary and a drugreference table in accordance with one or more embodiments of theinvention; and

[0030]FIG. 5 illustrates a graphical user interface displaying scheduledmedications in accordance with one or more embodiments of the invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0031] In the following description, reference is made to theaccompanying drawings which form a part hereof, and which is shown, byway of illustration, several embodiments of the present invention. It isunderstood that other embodiments may be utilized and structural changesmay be made without departing from the scope of the present invention.

[0032] Overview

[0033] A medication management system utilizes display rules thatprovide medication descriptive information that is accurate, consistentin appearance and easily recognized by system users and capable of beingsorted in a manner that ensures users have visibility to all medicationswithin either a selected generic or brand-name group. Descriptiveinformation that is controlled and managed in this manner contributes tothe overall medication management system goal of reducing, if noteliminating, potential medication errors at a patient's bedside.

[0034] Hardware Environment

[0035]FIG. 1 schematically illustrates a hardware and softwareenvironment in accordance with one or more embodiments of the invention,and more particularly, illustrates a typical distributed computer system100 using a network 102 to connect client systems 104 at a client 104bedside to server computers 106. A typical combination of resources mayinclude a network 102 comprising an intranet, the Internet, LANs, WANs,SNA networks, or the like, clients 104 operating/used at a client's 104bedside that are personal computers, workstations, pen tablets, WindowsCE devices, etc., and servers 106 that are personal computers,workstations, minicomputers, mainframes, etc. Additionally, client 104and server 106 may receive input using a touch pad display 108, keyboard118, bar code scanner 120, cursor control device, or other input device.

[0036] In accordance with one or more embodiments of the invention, anetwork 102 such as the Internet or a hospital intranet connects clients104 to server computers 106. Additionally, network 102 may utilize radiofrequency (RF) to connect and provide the communication between clients104 and servers 106. Clients 104 may execute a client application or Webbrowsers on display 108 and communicate with server computers 106executing Web servers 110. Such a Web browser is typically a programsuch as NETSCAPE NAVIGATOR or MICROSOFT INTERNET EXPLORER. Further, thesoftware executing on clients 104 may be downloaded from server computer106 to client computers 104 and installed as a plug in or ActiveXcontrol of a Web browser. Accordingly, clients 104 may utilize ActiveXcomponents/component object model (COM) or distributed COM (DCOM)components to provide a user interface or presentation layer on display108. The Web server 110 is typically a program such as IBM's HyperTextTransport Protocol (HTTP) Server or Microsoft's Internet InformationServer. Thus, server 106 provides business logic to control a system ofthe invention and to communicate with client 104.

[0037] In one or more embodiments of the invention, web server 110 hostsan Active Server Page (ASP) or Internet Server Application ProgrammingInterface (ISAPI) application 112, which may be executing scripts. Thescripts invoke objects that execute business logic (referred to asbusiness objects). The business objects then manipulate data in database116 through a database management system (DBMS) 114. When a developerencapsulates the business functionality into objects, the system may bereferred to as a component object model (COM) system. Accordingly, thescripts executing on web server 110 (and/or application 112) invoke COMobjects that implement the business logic. Further, server 106 mayutilize Microsoft's Transaction Server (MTS) to access required datastored in database 116 via an interface such as ADO (Active DataObjects), OLE DB (Object Linking and Embedding DataBase), or ODBC (OpenDataBase Connectivity).

[0038] Generally, these components 108-120 all comprise logic and/ordata that is embodied in or retrievable from device, medium, signal, orcarrier, e.g., a data storage device, a data communications device, aremote computer or device coupled to the computer via a network or viaanother data communications device, etc. Moreover, this logic and/ordata, when read, executed, and/or interpreted, results in the stepsnecessary to implement and/or use the present invention being performed.

[0039] Thus, embodiments of the invention may be implemented as amethod, apparatus, or article of manufacture using standard programniingand/or engineering techniques to produce software, firmware, hardware,or any combination thereof. The term “article of manufacture” (oralternatively, “computer program product”) as used herein is intended toencompass logic and/or data accessible from any computer-readabledevice, carrier, or media.

[0040] Those skilled in the art will recognize many modifications may bemade to this exemplary environment without departing from the scope ofthe present invention. For example, those skilled in the art willrecognize that any combination of the above components, or any number ofdifferent components, including different logic, data, differentperipherals, and different devices, may be used to implement the presentinvention, so long as similar functions are performed thereby.

[0041] Software Embodiments

[0042] A software product used primarily by nurses and other healthcareprofessionals in a hospital setting may be utilized in accordance withembodiments of the invention. The software product enables hospitals toreduce medication errors by electronically verifying at the patientbedside, the “five rights” (right patient, right drug, right dose, rightroute of administration, and right time) before the drug is administeredto the patient. Additionally, the software product may provide for theelectronic verification of the compliance/violation of multipleadditional compliance rules maintained by the system or entered by auser. The compliance rules provide for the verification of medicationadministration well beyond the traditional “five rights”. The systemalso provides valuable and comprehensive medication information neededto continually improve the safety and quality of the hospital'smedication management system and patient outcomes.

[0043] Multiple pharmacies and hospitals construct a formulary that isused to represent and store medication information. Since differentformularies are constructed by multiple pharmacies over time, themedication information is not represented consistently. Thus, differentpharmacies/hospitals utilize different formularies and the data andabbreviations therein to represent the same medication. Suchinconsistencies are a significant cause of medication error.

[0044] To reduce or prevent medication errors resulting from theseinconsistencies, one or more embodiments of the invention utilizevarious components that are collectively referred to as display rulesthat provide medication description information that is accurate,consistent in appearance and easily recognized by system users. Suchdisplay rules also provide the capability for the medication descriptioninformation to be sorted in a manner that ensures users have visibilityto all medications within either a selected generic or brand-name group.Descriptive information that is controlled and managed in this mannercontributes to the overall system of reducing, if not eliminating,potential medication errors at the bedside.

[0045] For example, if the dosage form in a formulary is “TAB”, one ormore display rule components may provide for expanding the abbreviationinto “TABLET”. Similar display rule components may be utilized toconvert medication names, dosage forms, dosage route, etc. Using suchdisplay rule components, different hospital formularies may all utilizea consistent format for medication information. Thus, there isconsistency between physicians, nurses, and pharmacists with respect towriting, viewing, and administering orders. Further, bymapping/converting the medication information to a consistent format,data warehousing/mining of the medication information may more easily beperformed. The usefulness of such data warehousing increases as the datais aggregated across multiple hospitals/pharmacies.

[0046] One or more of the following components form the basic structureutilized in accordance with one or more embodiments of the invention:

[0047] (1) Medication Description Management;

[0048] (2) Data Reconstruction;

[0049] (3) Element and Attribute Rules; and

[0050] (4) Hospital Setup Tool.

[0051] Medication Description Management

[0052] Medication descriptions must provide information that issufficiently detailed so that it is clearly identifiable as the “rightdrug”. Part of that need is provided for by the description's contentand part by its appearance. The medication description managementcomponent provides the overall structure and procedure that is utilizedto ensure the accuracy and consistency of a medication description'scontent and appearance.

[0053]FIG. 2 illustrates the flow of information as provided by themedication description component in accordance with one or moreembodiments of the invention. Third party providers such as First DataBank, Multim, or Micromedix maintain databases 202 of themedications/drugs in existence (e.g., the NDDF (National Drug Data File)from First Data Bank). Such databases 202 include information such asmedication names, dosage route, allergy-drug interactions, food-druginteractions, patient educational materials, etc. as published by thedrug manufacturers and collected by the third party providers. Relevantdata 204 from database 202 is extracted and input into a reference drugtable 206. Accordingly, reference drug table 206 contains relevantorganized medication information.

[0054] The reference drug table 206 is combined with ahospital's/pharmacy's internal formulary 208 and assembled using ahospital setup tool 210 (also referred to as the hospital formulary toolor display name manager tool) into a hospital formulary file (HFF) 212.The hospital setup tool 210 aids users in creating and providingconsistent medication description content and appearance for storage inthe hospital formulary file 212.

[0055] Accordingly, the content of a medication description and how thatcontent appears/is displayed is generated from various elements that aregathered from both the reference drug table 206 and hospital formulary208. Examples of the elements used (from both drug reference table 206and pharmacy formulary 208) to create the medication description aredisplay name, generic name, brand name, drug strength, package size, anddosage form. Various make-safe rules (see discussion below) are utilizedto calculate a set of display-related elements of the medicationdescription. The display-related elements, in turn, are used toconstruct a final displayed medication description by stringing togetherthe display-related elements in a controlled manner that determineswhich of the display-related elements are to be used, and where theelements are to be used as part of a final displayable medicationdescription.

[0056] Every medication is tested against a specified set of make-saferules in order to construct its final medication description. The finalmedication description is then stored in the HFF 212 as an additionalelement. Thus, the drug reference table 206, pharmacy formulary 208,make-safe rules, and hospital setup tool 210 are utilized to create thefinal medication description from various elements that are eventuallystored within the HFF 212.

[0057] Accordingly, the final medication description is provided by HFF212, and used for display on display 108. The features that are utilizedin the creation of the medication description and final medicationdescription may be specified by the make-safe rules as described below.

[0058] Data Reconstruction

[0059] Although the database 202 or pharmacy formulary 208 may provide asignificant amount of data, the databases 202 and 208 often cannotsupply complete data that can be stored and managed in a system of theinvention. For example, medications that have a combination of drugs ofdiffering strengths do not show numerical data of the drug amounts.Further, many times, the strength units of the drugs are not provided.The system specifies how incomplete data is to be reconstructed basedupon all of the available information provided by the database 202 andpharmacy formulary 208. The numerical data can be reconstructed into thedrug reference table 206 or hospital formulary file 212 and indicate the“extrapolated units” or other missing information.

[0060] The data may be reconstructed based on the information provided.Accordingly, if the pharmacy formula 208 contains complete national drugcode (NDC) information for a listed medication, data for the medicationwith the matching NDC is retrieved from the drug reference table 206.Additionally, the system may attempt to locate a matching medication indrug reference table 206 based on one or more fields/elements frompharmacy formulary 208. For example, if pharmacy formulary 208 containsa name and administration route, the medication with a matching name(generic or brand) and administration route will be attempted. Selectedfields, from pharmacy formulary 208 may be utilized, preferred, or givenprecedence in attempting to locate a matching medication in drugreference table 206. Such precedence resolves inconsistencies with thedata in pharmacy formulary 208.

[0061] Element and Attribute Rules

[0062] Element and attribute rules are applied to elements andattributes of a medication to ensure the medication maintains consistentand accurate content and appearance. The rules may be used to create newattributes and elements or to ensure the accuracy of information inexisting attributes and elements.

[0063] A final medication description's content and appearance may bebased upon various elements. One such element is a “display name”element. The “display name” element may have two forms: one display namebased upon the medication's generic name, the other based upon its brandname (both of which are maintained in drug reference table 206). Thepurpose of having the two forms allows the medications to be sorted byeither generic or brand name, thereby providing the user with an optionif one of the names is known and not the other.

[0064] Element and attribute rules may be grouped into variouscategories focusing on specific aspects of the elements of a medicationdescription as follows:

[0065] Make Safe Rules

[0066] As described above, the medication descriptions are based uponthe generic and brand names extracted from database 202. After obtaininga display name for a medication, the name must be formatted forappropriate use and display. Make safe rules are utilized to format andadjust the medication descriptions for this purpose. Make safe rulesprovide for formatting the display names for easier reading andmodifying the display names so that the reference drug table 206acronyms, abbreviations, and typographical errors are transformed intofull and complete terminologies that are consistent across the entirespectrum of all medications placed into HFF 212.

[0067] The make safe rules gather the data from various elements toensure that detailed medication information is accurate and consistent.Make safe rules provide the ability for server 106 to create “safe”values for various drug attributes/elements, including proper spacingand special formatting. Accordingly, some “make safe” rules ensure thatcertain fields are in the proper format and contain the appropriateinformation. For example, when a “make safe” procedure is called, theprocedure may ensure the proper format and information is maintained fordrug strength units, drug strength volume units, max daily dose units,etc.

[0068] A single “make safe” procedure may be utilized in accordance withone or more embodiments of the invention. When the single “make safe”procedure is called, the caller includes the attributes/elements to makesafe as parameters of the function call. The “make safe” procedurereturns a value that has been made “safe”.

[0069] Units of Measurement Rules

[0070] One or more make safe rules may be applied to elements related tothe units of measurement (UOM) for the medications. A UOM specifies theunit utilized to quantify and measure the medication. For example, a UOMmay be Billion Units, mL, mm, 1000, etc. A UOM may comprise a stringcomponent and a numerical value component. For example, the UOM stringcomponent may be gram or G, and the UOM numerical value component may be1,000,000, 1,000, etc.

[0071] Make safe rules that are UOM (referred to as UOM rules) relatedensure that both the string and numerical value are consistent units ofmeasurement across all medications. For example, one UOM rule removestrailing zeroes from the numerical value (e.g., 1 and not 1.0). AnotherUOM rule stores leading zeroes in the numerical value (e.g., 0.1 and not0.1) and add commas for numbers greater than or equal to 1000 (e.g.,1,000). An additional UOM rule modifies the UOM string to ensureconsistent capitalization and abbreviation. For example, CM is changedto cm, ML is changed to mL, centimeters is changed to cm, and “″” ischanged to inches.

[0072] UOM rules may also modify the string or numerical value dependingon each element's value. For example, if the string is “G” and thenumerical value is less than 1, the string may be converted to mg andthe numerical value may be multiplied by 1000. In another example, ifthe numerical value is 1,000,000,000, the string may be modified to“Billion Units”. In another example, if the string is “MU,” and thenumerical value is greater than or equal to 1,000,000, then the stringmay be changed to “Billion Units” and the numerical value may be dividedby 1,000,000. Inconsistencies between the numerical value and string mayalso be located and adjusted. For example, if the numerical value is1,500,000 and the string is BU or Billion units, the numerical value maybe given precedence such that the string is changed to Million Units.

[0073] UOM rules may also ensure proper spacing between strengthnumbers, unit volume, weight, and rates. For example, a UOM rule mayensure that there is a space between a strength number and units (e.g.,5 mL and not 5 mL). In another example, a make safe rule may ensure thatnumerical values are used in weights and rates (e.g., 50 mL/1 hr and not50 mL/hr).

[0074] Accordingly, the UOM rules ensure that both the string andnumerical value are consistent units of measurement across allmedications.

[0075] Compression Rules

[0076] Compression rules provide for creating “compressed” values ofdrug attributes/elements and ensuring that drug strength values arecreated and stored within a 10-character limit. Compression rulesinclude the removal of trailing and leading zeroes and spaces, theremoval of spaces and dashes in fractions (e.g., 1-½becomes 1½), and theabbreviation of common terms (e.g., in becomes”, feet becomes ft, etc.).

[0077] Display Name Creation and Storage Rules

[0078] For each medication item, display name creation and storage rulesprovide for the creation and storage of generic and brand names for themedications that are displayed on display device 108. Such rules mayutilize and refer to a spreadsheet file containing the relevantdescription/elements.

[0079] To provide an initial medication description that is usedinternally for applying and modifying rules and to obtain desiredordered medication descriptions, the following attributes may beconcatenated with single space separators between each attribute:

[0080] (1) display name (generic or brand);

[0081] (2) display strength;

[0082] (3) display package strength;

[0083] (4) display package amount;

[0084] (5) display package size;

[0085] (6) display package description; and

[0086] (7) display dosage form.

[0087] Each of the above attributes is based on additional attributes.For example, the display package size attribute may be a combination ofthe package size and the package size units from drug reference table206. Further, a make safe procedure that ensures proper formatting,capitalization, spacing, etc. may be executed to create/determine eachof the above attributes. For example, the following code may be utilizedto create the display package size attribute:

DisplayPackageSize=MakeSafe(Str(PackageSize)+(PackageSizeUnits)

[0088] In addition to the medication description that utilizes the aboveelements, the system may generate a different final medicationdescription that is utilized to present the medication description on adisplay 108 to users. The final medication description may utilize thefollowing elements, if available:

[0089] (1) the generic or brand display name;

[0090] (2) the display strength; and

[0091] (3) the display dosage form.

[0092] Subsequent to the above three elements, the route information isinserted (if not already present). For example, if the medication is anose/nasal spray, the delivery route “nasal” may be inserted into thefinal medication description. Similarly, the medication delivery routeterms ophthalmic, otic, etc. may be inserted into the final medicationdescription.

[0093] The final medication description may also be modified based on asequence number for specific medications. For example, if a medication'ssequence number matches a sequence number in a predefined table, thefinal description may be modified such that the medication name isfollowed by the display package amount and the display package size. Forexample, the final medication description from a predefined table may be“Lidocaine+DisplayPackageAmount+“in”+DisplayPackageSize+“_D5W”s.

[0094] The final medication description also includes a default strengthand strength units that may be retrieved from a predefined table orbased on additional attributes/elements.

[0095] Package Size Units Rules

[0096] For each medication item, the package size units is obtained andstored. During the obtaining process, formatting issues such ascapitalization and abbreviations are corrected. For example, “TAB” maybe changed to “Tab”, “CAP” may be changed to “Cap”, and “BAG” may bechanged to “Bag”. Additionally, predefined reference numbers may beconverted to the corresponding package size units. For example, if adosage form is “2”, the package size may be converted to “mL”.

[0097] If medication strength values are not provided or available inthe drug reference table 206, package size rules add appropriate values.For example, if the generic or brand name of the medication contains theword “child”, the medication strength may be specified as “PEDIATRIC”.

[0098] Medication strength related elements may be adjusted based onindependent information available to the system. Accordingly, generalindependent strength related information is obtained and detailedinformation that is consistent therewith is determined. Relevantelements and fields may be compared to tables containing data and emptyfields may be instantiated when a match is found. For example, a “makesafe” procedure may be called that utilizes, compares, and confirms thatthe independent information is not inconsistent and may suggest or adoptadditional strength related information based on the independentinformation. In a specific example, a make safe procedure may retrieveindependent information that provides for a single component and timerate strength. The component and time rate strength information isconverted into specific information for UOM strings. Thus, if the drugstrength is *MM/*ML, then the unit is milliMoles per volume, and theappropriate strength related information such as strength units, volumeunits, display strength, etc. are instantiated with the appropriateinformation. In another example, a search for a sequence number in atable may be conducted and strength related values from the table into adrug object item may be instantiated if the sequence number is found.

[0099] Hospital Setup Tool

[0100] Substitutions and modifications of the medication description toensure that the data is reconstructed accurately may be performed byclinical personnel using the hospital setup tool (HST)/display namemanager tool 210 to create a set of accurate and consistent displaynames in the hospital formulary file 212.

[0101] Using the HST 210 and the data from drug reference table 206,pharmacy formulary 208, and the make safe rules, detailed medicationinformation may be adjusted and modified. Thereafter, a final medicationdescription is created for each medication to be stored in the formularyfile 212 by appending various display-related elements to the displayname in a software-controlled process based upon certain medicationparameters.

[0102] The hospital setup tool 210 provides for the verification ofmedication information utilized in a hospital formulary file 212. FIG. 3is a flow chart illustrating the use of the hospital setup tool 210 inaccordance with one or more embodiments of the invention. Three primarysteps are involved in properly configuring and setting up the hospitalformulary file 212 using the hospital setup tool 210: (1) importingformulary data 302; (2) mapping the formulary data; and (3) outputtingthe appropriate data into the hospital formulary file 212.

[0103] Importing pharmacy formulary data 208 is the first step 302 insetting up the hospital formulary file 212. The pharmacy formulary data208 is usually comma separated data regarding medications offered by apharmacy. The formulary data 208 is parsed at step 308 to find andcorrect any formatting errors. For example, the lengths of fields may becompared to maximum field lengths, dashes in NDC numbers may be removed,primary keys (e.g., row IDs) may be checked for uniqueness, and fieldsthat should only contain numerals or letters are checked to ensure thatonly numerals or letters ate contained within them. A summary of theformatting errors that could not be automatically corrected may bepresented to the user. The user may then have the option to manuallycorrect the appropriate entries at step 310.

[0104] Once the formatting of the formulary data 208 has been modified(if necessary) and accepted by the user, the formulary data 208 is inputinto an internal database/table of the data referred to as the HST(hospital site table) site formulary. Once the data is input into theHST site formulary, the importing process 302 is complete.

[0105] Step 304 (mapping the data) provides the user with the option tomap the pharmacy formulary data 208 to drug reference table data 206 andto view, modify, and accept the medication description. FIG. 4illustrates the graphical user interface utilized in mapping step 304.At step 314, the formulary data from the pharmacy formulary 208 islisted (e.g., in column 402).

[0106] At step 316, the system attempts to match the pharmacy formularydata 208 with data from the drug reference table 206. If a match orpotential match are found, the suggested drug reference table data 206may be listed (e.g., in column 406) at step 318. Additionally, theinformation that the user elects to use to represent each element in thehospital formulary file 212 may be listed (i.e., in column 404). Forease of use, the individual elements of a medication description may bedisplayed in individual fields with each field of the pharmacy formularydata 208 adjacent to or in the same row of a corresponding element thatis suggested. For example, the row indicating the dosage form 408 of amedication may indicate the type of field (i.e., “Dosage Form:”) in onecolumn, the pharmacy/site formulary dosage form in a second column 402(i.e., “CAPSULE”), the item to be created in a third column (i.e.,“Capsule, Hard, Soft, etc. (Cap . . . ”) 404, and the suggestion/matchin a fourth column 406 (i.e., “Capsule, Hard, Soft, etc. (Cap . . . ”).

[0107] Once both the formulary data 208 and the suggestion from drugreference table 206 are displayed, modifications to the medicationinformation may be obtained from the user at step 320. The user examineseach medication using the graphical user interface (GUI) of FIG. 4. Asdescribed above, each column in the GUI comprises information relatingto the medication. One column (e.g., column 404) is utilized to displaythe user's selection of the final representation and form of the data.The default information contained within the column 404 may be thesuggestion/match from column 406. Further, certain elements may not bemodifiable by the user (e.g., the generic or brand name). A user canelect to automatically transfer the text from column 402 (i.e., thepharmacy formulary data 208) or from column 406 (i.e., thesuggested/matched data 206) into column 404.

[0108] The user can manually modify the data in column 404 by deleting,copying, typing, etc. directly into the fields in column 404. If data incolumn 404 is changed by the user, upon the user electing to save thedata, the medication description data 410 may be modified to reflect thechanges. Accordingly, the medication description 410 is based on theelements (from column 404) used to represent the medication. Further,the medication description 410 can be modified directly to add desiredinformation or notes to be displayed (e.g., “MUST BE ORAL”). Themedication description 410 of column 404 is the description that will bedisplayed and utilized by users of the system. Accordingly, thedescription should be consistent across multiple sites. By providing thesuggestion from column 406 and the ability for a user to modifymedication information, the appropriate medication and a consistentdisplay/reference to the medication is utilized.

[0109] The GUI of FIG. 4 may also provide flags or color coding toindicate when changes have been made or when particular fields need tobe confirmed/checked. For example, if the user modifies a field incolumn 404 that differs from the suggestion in column 406, a flag may bedisplayed adjacent to the row containing the modified entry.Alternatively, the changed field may be highlighted or displayed in adifferent color.

[0110] If important information is changed by the user at step 320, theuser may be prompted to confirm the change and/or to confirm whether theupdated or original information should be utilized when clinical checksare conducted. In other words, the user is given the option of whetheror not to link to the remaining data (that is not hidden from the user)for the medication as suggested in column 406.

[0111] Once linked, the data for the medication indicated in column 406is utilized in clinical checks. As described above, clinical checksconfirm that the administration of medication does not violate a seriesof rules and provide warnings to users when a rule violation occurs. Forexample, if a nurse attempts to administer secobarbital by injection, alink to the route information in column 406 may enable the display of awarning to the nurse to administer the prescription orally. Further,information related to secobarbital but not displayed in the GUI mayalso be utilized.

[0112] Linking may be desirable because some clinical rules may needclinical information for the linked drug even if a field has beenchanged. For example, if the package size is changed or a percentagevalue is changed, the information for the medication may still beutilized in clinical checks. Alternatively, linking may not be desirableif the medication has been significantly changed in column 404 from thatlisted in column 406. For example, if the user is listing a banana as amedication in column 404 and the only suggestion that is found is foropium, the user would likely not want to link the banana to opium suchthat clinical checks will use the attributes for opium when a banana isprescribed. In another example, suppose secobarbital is traditionallyadministered orally but the hospital is utilizing a new method ofcrushing the pill, mixing the pill with intravenous fluid (IV) andadministering the mixture through intravenously. In such a situation,the pharmacist still needs to modify the information in column 404.However, the pharmacist may still desire to link the new mixture to theoriginal secobarbital record in column 406 for use in clinical checks.Accordingly, the pharmacist is provided the option of linking themedication to the original medication or match listed in column 406.

[0113] Step 316 attempts to match the site formulary data 208 with drugreference table data 206. Once a match is found, column 406 displays theresulting match. If the displayed information in column 406 is not theappropriate medication/information, a user may directly enter theinformation and/or search for the appropriate medication/information byselecting the find button 412. In response, a GUI for conducting a queryof the drug reference table 206 information may be utilized to searchand retrieve medication information. Additionally, a “smart” search maybe conducted that provides the ability to locate the “best” match basedon the dosage form, brand name, dosage strength, and/or generic name.Using a smart search, if an exact match cannot be found, the GUIdisplays a list of those medications that contain the most matches. Theuser may select one of the listed medications to retrieve the relatedmedication information. Once selected, the retrieved information isdisplayed in column 406 for the user to work with and modify if desired.

[0114] If the desired medication is not suggested (or cannot be found bythe user), the approval of the formulary information in column 402 maybe postponed until a later time by selecting the postpone button 414.

[0115] The system may also maintain a full audit trail that tracks anychanges made in column 404, who made the changes, what the user wasviewing when the change was made, when the changes were made, whatquestions were answered (and the responses to the questions), and otherrelevant auditing information. Accordingly, when mistakes areencountered, the audit trail may be viewed to determine the relevantinformation about the user and the actions taken when the mistake wasentered into the system.

[0116] Once the user using the GUI of FIG. 4 has verified all of themedications, a final verification screen provides the user with theoption to save and/or export the validated medication data. Accordingly,once the medications have all been verified, mapping step 304 iscomplete and the data may be output to the hospital formulary file 212at step 320. Further, once the user has selected to save/output thedata, various formatting checks may be performed once again. Forexample, the system may ensure that primary keys are unique, fieldlengths are appropriate, and characters and numerals are utilizedappropriately. Once saved/output to the HFF 212, the HFF 212 may beutilized and accessed to retrieve medication information and to obtainthe medication description to be displayed/utilized throughout thesite/hospital.

[0117] Accordingly, the medication description management, make saferules, data reconstruction, and hospital setup tool components areutilized to provide accurate medication description content andappearance.

[0118] Graphical User Interface

[0119] Once the medication elements, attributes, and descriptions havebeen made “safe”, and transferred into HFF 212, a graphical userinterface (GUI) provides for the display of the relevant information invarious formats and screens/areas.

[0120] GUI display areas may include a components display and amedications display. The components display may include various tabs forlisting the components, entering observations, and entering theadministration of the component. The medications display may include ascheduled medications screen, a PRN screen, an IV screen, an all screen,a floorstock screen, and a formulary screen.

[0121] To ensure that the medication orders properly and consistentlyidentify the medication and comply with the five patient rights (i.e.,right patient, right drug, right dose, right route of administration,and right time), the elements and attributes from HFF 212 are utilizedand the medication description utilized remains consistent throughoutall of the display screens. Further additional compliance checks may beperformed using the elements and attributes from HFF 212 to protectagainst medication errors.

[0122] Accordingly, medications on each screen are displayed using threecolumns. The first column contains either the generic or brand finaldisplay medication description depending on the user's selection. Column2 comprises either the display package size, display package strength,or display strength. Column 3 comprises either the display packagedescription, display dosage form, or an empty field. Using thisthree-columnar format, relevant consistent medication information thatprovides the ability to properly and completely identify the medicationis displayed and utilized by the user. For any patient order, themedication displayed always provides the order give amount, the ordergive units, and the order display name (created using the final displaymedication description). Additionally, a pop-up window containing theentire medication description may be displayed when the display cursoris placed over any listed medication/order.

[0123] For component orders, a components tab/screen with each componentand the amount of the component is provided. Component orders are orderswherein various components are added together to create a completeproduct. For example, a component order may call for the use of eight(8) different components to utilize in an intravenous solution (e.g.,600 mL Dextrose in Water, 400 mL Sterile Water, 250 mL Fat Emulsions10%, 40 mEq KCI, 4.65 mEq CaGlucon, 8 mEq MagSulf, 10 mM Kphos, andNaPH).

[0124]FIG. 5 illustrates a scheduled medication GUI screen in accordancewith one or more embodiments of the invention. A scheduled medicationlist/screen identifies dose times/time due of the medication (usingmilitary time) 502, the name of the medication (using the consistentmedication description) 504, and the last time the medication wasadministered (if any) 506. Additionally, the screen may indicate whetherthe scheduled medication is for a confirmed and active order and mayprovide a list of previously administered medications. When a nurseelects to administer a particular listed/scheduled medication, detailsof the medication are displayed. For example, when a nurse selects aparticular prescription for administration, the route of theadministration (e.g., IV) is displayed to the nurse.

[0125] The PRN screen provides for medications that are pro re nata(given on demand). The PRN medication is listed with the consistentmedication description followed by the last time the PRN medication wasadministered in a separate column. The PRN screen follows the sameguidelines utilized for the scheduled medications screen.

[0126] The IV screen displays all of the IV medication orders for agiven patient. Each medication listed in the IV screen is alsoaccompanied by the strength and rate for administering the medicationintravenously.

[0127] The all medications screen/list provides details on all patientorders and medications (IV, PRN, or otherwise) for a given patient. Eachmedication/patient order is listed with the appropriate strength,dosage, rate, etc. related information as provided on the other screensof the GUI. For example, the time the medication was last administeredand the order state (e.g., active, on hold, future, expired, etc.) maybe displayed adjacent to PRN and scheduled medications.

[0128] The floorstock screen provides a listing of the patientorders/scheduled medications that are retrieved from the floorstockwhere the patient is located. For example, Tylenol may be retrieved fromthe floorstock and administered to the patient.

[0129] The formulary screen provides a listing of the patientorders/scheduled medications that are obtained/retrieved from thehospital's pharmacy. Such medications can include pain medications suchas Morphine or tablets of antibiotics such as Keflex.

[0130] Once the nurse or person administering the medication selects amedication from one of the above screens, detailed information regardingthe medication is displayed to the user. The detailed information allowsthe administer of the medication to confirm or delete one, some, or allof the medications as they are administered to the patient. Aconfirmation screen may present additional information such as the timethe medication was administered, the name of the administer of themedication, and a co-signature (if required for the medication).Additionally, the confirmation or detailed medication screen mayindicate the dose amount, dose unit, rate, route units, and route.

[0131] Conclusion

[0132] This concludes the description of one or more embodiments of theinvention. The following describes some alternative embodiments foraccomplishing the present invention. For example, any type of computer,such as a mainframe, minicomputer, pen tablet, CE device, or personalcomputer, or computer configuration, such as a timesharing mainframe,local area network, or standalone personal computer, could be used withthe present invention. In summary, embodiments of the invention providethe ability to consistently display access, and utilize medicationinformation including medication descriptions.

[0133] The foregoing description of the preferred embodiment of theinvention has been presented for the purposes of illustration anddescription. It is not intended to be exhaustive or to limit theinvention to the precise form disclosed. Many modifications andvariations are possible in light of the above teaching. It is intendedthat the scope of the invention be limited not by this detaileddescription, but rather by the claims appended hereto.

We claim:
 1. A computer-implemented method for displaying consistentmedication information comprising: creating an electronic drug referencetable comprised of medication information; receiving an electronicformulary comprising formulary medication information; creating anelectronic formulary file comprising medication information content,wherein the medication information content comprises a combination ofthe electronic drug reference table and the electronic formulary; anddisplaying the medication information content.
 2. The method of claim 1,wherein the medication information is obtained from one or more drugmanufacturers.
 3. The method of claim 1 wherein the medicationinformation content is displayed at a time of administration ofmedication.
 4. The method of claim 1 wherein the medication informationcontent is displayed at a time of prescribing medication.
 5. The methodof claim 1 wherein the medication information content is displayed at atime of computerized prescription order entry.
 6. The method of claim 1wherein the electronic formulary is received from a hospital.
 7. Themethod of claim 1 wherein the electronic formulary is received from apharmacy.
 8. The method of claim 1 wherein the creating of theelectronic formulary file further comprises applying one or more rulesthat ensure the medication information content and appearance isconsistent and accurate.
 9. The method of claim 1 wherein the creatingcomprises providing a hospital setup tool that enables a user to modifyand approve medication information content to be placed into theelectronic formulary file.
 10. The method of claim 1 wherein themedication information content displayed is based on patient orders fora specified patient.
 11. An apparatus for displaying consistentmedication information in a computer system comprising: means forcreating an electronic drug reference table comprised of medicationinformation; means for receiving an electronic formulary comprisingformulary medication information; means for creating an electronicformulary file comprising medication information content, wherein themedication information content comprises a combination of the electronicdrug reference table and the electronic formulary; and means fordisplaying the medication information content.
 12. The apparatus ofclaim 11, wherein the medication information is obtained from one ormore drug manufacturers.
 13. The apparatus of claim 11 wherein themedication information content is displayed at a time of administrationof medication.
 14. The apparatus of claim 11 wherein the medicationinformation content is displayed at a time of prescribing medication.15. The apparatus of claim 11 wherein the medication information contentis displayed at a time of computerized prescription order entry.
 16. Theapparatus of claim 11 wherein the electronic formulary is received froma hospital.
 17. The apparatus of claim 11 wherein the electronicformulary is received from a pharmacy.
 18. The apparatus of claim 11wherein the means for creating the electronic formulary file comprisesmeans for applying one or more rules that ensure the medicationinformation content and appearance is consistent and accurate.
 19. Theapparatus of claim 11 wherein the means for creating comprise means forproviding a hospital setup tool that enables a user to modify andapprove medication information content to be placed into the electronicformulary file.
 20. The apparatus of claim 11 wherein the medicationinformation content displayed is based on patient orders for a specifiedpatient.
 21. An article of manufacture comprising a program storagemedium readable by a computer and embodying one or more instructionsexecutable by the computer to perform a method for displaying consistentmedication information, the method comprising: creating an electronicdrug reference table comprised of medication information; receiving anelectronic formulary comprising formulary medication information;creating an electronic formulary file comprising medication informationcontent, wherein the medication information content comprises acombination of the electronic drug reference table and the electronicformulary; and displaying the medication information content.
 22. Thearticle of manufacture of claim 21, wherein the medication informationis obtained from one or more drug manufacturers.
 23. The article ofmanufacture of claim 21 wherein the medication information content isdisplayed at a time of administration of medication.
 24. The article ofmanufacture of claim 21 wherein the medication information content isdisplayed at a time of prescribing medication.
 25. The article ofmanufacture of claim 21 wherein the medication information content isdisplayed at a time of computerized prescription order entry.
 26. Thearticle of manufacture of claim 21 wherein the electronic formulary isreceived from a hospital.
 27. The article of manufacture of claim 21wherein the electronic formulary is received from a pharmacy.
 28. Thearticle of manufacture of claim 21 wherein the creating of theelectronic formulary file further comprises applying one or more rulesthat ensure the medication information content and appearance isconsistent and accurate.
 29. The article of manufacture of claim 21wherein the creating comprises providing a hospital setup tool thatenables a user to modify and approve medication information content tobe placed into the electronic formulary file.
 30. The article ofmanufacture of claim 21 wherein the medication information contentdisplayed is based on patient orders for a specified patient.